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Sleep Disorder Due to a General Medical Condition
DSM-IV For more information, see Mental Disorders Due to a General Medical Condition Diagnostic Criteria A'''. A prominent disturbance in sleep that is sufficiently severe to warrant independent clinical attention. '''B. There is evidence from the history, physical examination, or laboratory findings that the sleep disturbance is the direct physiological consequence of a general medical condition. C'''. The disturbance is not better accounted for by another mental disorder (e.g., an Adjustment Disorder in which the stressor is a serious medical illness). '''D. The disturbance does not occur exclusively during the course of a delirium. E'''. The disturbance does not meet the criteria for Breathing-Related Sleep Disorder or Narcolepsy. '''F. The sleep disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. Specify type: * Insomnia Type: if the predominant sleep disturbance is insomnia * Hypersomnia Type: if the predominant sleep disturbance is hypersomnia * Parasomnia Type: if the predominant sleep disturbance is a Parasomnia * Mixed Type: if more than one sleep disturbance is present and none predominates Note: Include the name of the general medical condition, e.g., Sleep Disorder Due to Chronic Obstructive Pulmonary Disease, Insomnia Type; also record the general medical condition. Subtypes The subtypes listed below can be used to indicate which of the following symptom presentations predominates. The clinical presentation of the specific Sleep Disorder Due to a General Medical Condition may resemble that of the analogous primary Sleep Disorder. However, the full criteria for the analogous primary Sleep Disorder do not need to be met to assign a diagnosis of Sleep Disorder Due to a General Medical Condition. Insomnia Type This subtype refers to a sleep complaint characterized primarily by difficulty falling asleep, difficulty maintaining sleep, or a feelings of nonrestorative sleep. Hypersomnia Type This subtype is used when the predominant complaint is one of excessively long nocturnal sleep or of excessive sleepiness during waking hours. Parasomnia Type This subtype refers to a sleep disturbance characterized primarily by abnormal behavioral events that occur in association with sleep or sleep transitions. Mixed Type This subtype should be used to designate a sleep problem due to a general medical condition characterized by multiple sleep symptoms but no symptom clearly predominates. Recording Procedures In recording the diagnosis of Sleep Disorder Due to a General Medical Condition, the clinician should note both the specific phenomenology of the disturbance, including the appropriate subtype, and the specific general medical condition judged to be causing the disturbance (e.g., Sleep Disorder Due to Thyrotoxicosis, Insomnia Type). The general medical condition should also be noted (e.g., thyrotoxicosis). Differential Diagnosis Sleep Disorder Due to a General Medical Condition must be differentiated from expected disruptions in sleep patterns, primary Sleep Disorders, Sleep Disorders Related to Another Mental Disorder, and Substance-Induced Sleep Disorders. Sleep disruption Many individuals experience sleep disruption during the course of a general medical or neurological condition. In the majority of cases, such complaints do not merit an additional diagnosis of a Sleep Disorder. Rather, a diagnosis of Sleep Disorder Due to a general Medical Condition should be reserved for cases in which the sleep disturbance is a very prominent clinical feature, atypical symptoms are present, or the individual is sufficiently distressed by the sleep symptom or attendant impairment that specific treatment for this disturbance is required. Primary Sleep Disorders Sleep Disorders Due to a General Medical Condition are characterized by symptoms similar to those in primary Sleep Disorders. The differential diagnosis rests not on specific symptoms, but rather on the presence or absence of a medical condition judged to be etiologically related to the sleep complaint. In the specific cases of Narcolepsy and Breathing-Related Sleep Disorder, the underlying etiology of the sleep disturbance is assumed to be a general medical condition. However, in these two specific examples, the general medical condition does not exist independent of sleep symptoms. For this reason, these two disorders are included in the "Primary Sleep Disorders" section. Substance-Induced Sleep Disorders Differentiating a Sleep Disorder Due to a General Medical Condition from Substance-Induced Sleep Disorder can prove very difficult. In many cases, individuals with a significant general medical condition often take medication for that condition; these medications in turn may cause sleep-related symptoms. For example, an individual may have sleep disruption related to asthma. However, that individual may also be treated with theophylline preparations, which in some cases can themselves cause sleep disturbance. Differentiating a Sleep Disorder Due to a General Medical Condition from a Substance-Induced Sleep Disorder often rests on chronology, response to treatment or discontinuation of medications, and longitudinal course. In some cases, concurrent diagnoses of Sleep Disorder Due to a General Medical Condition and Substance-Induced Sleep Disorder may be appropriate. In cases in which a drug of abuse is suspected to be the cause for the Sleep Disorder Due to a General Medical Condition. Dyssomnia or Parasomnia Not Otherwise Specified If the clinician cannot determine whether the sleep disturbance is primary, related to another mental disorder, due to a general medical condition, or substance induced, the appropriate diagnosis is Dyssomnia or Parasomnia Not Otherwise Specified. DSM-5 As of DSM-5, this diagnosis is no longer part of the DSM. For more information, see Sleep-Wake Disorders